Manipur: Negligible number of transgenders access free hepatitis treatment due to fear of stigma and discrimination

Despite transgender being one of the high-risk groups for infecting viral hepatitis B and C but the number of such communities availing the service of the National Viral Hepatitis Control Programme is negligible due to stigma and discrimination.

Viral hepatitis, a silent disease, is increasingly being recognized as a public health burden in India and in the world as well. It is estimated that 40 million people are infected by Hepatitis B and 6-12 million by Hepatitis C in India. Whereas in the global context, the number of persons who contracted by Hepatitis B and Hepatitis C in the world is 269 million and 58 million respectively.

With a vision to eliminate this viral disease by 2030, the government of India launched National Viral Hepatitis Control Programme (NVHCP) in the year 2018. Manipur government implemented the programme in the following year just in few hospitals. However, to make the programme easily accessible, implementation centres has been expanded even at district hospitals, primary health centres and community health centre. The programme was started with test and treat for viral hepatitis C but later in 2021 treatment for Hepatitis B was included.

The Manipur government is putting effort to reach this programme in association with NGOs. But sadly, treatment amongst the transgender community is negligible despite the fact that they are high risk of getting infected with this disease.

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According to information received from the Directorate of Health Services, only four transgenders have availed for treatment of Hepatitis C out of 1800 total patients. In the case of Hepatitis B 262, patients are diagnosed. Out of this, not a single person is transgender.

In an interaction with India Today NE, an outreach worker of Social Awareness Service Organization (SASO), an NGO working for the upliftment of people who inject drugs (PWID) and People Living with HIV or AIDS (PLHIV), Lourembam Naresh said that transgender is included amongst a high-risk group of HIV/AIDS and its co-infectious disease like viral hepatitis B and C. Its main reason is that they usually have multiple partners. Besides this they are prone to become a drug-dependent person to cope the stress that comes from daily battles driven by stigma and discrimination.

Naresh continued and said that considering all such factors, the health problem is one of the major issues of the transgender community. But fear of stigma, humiliation and prejudice, they are reluctant to seek for health treatment. Likewise in the case of viral hepatitis B and C treatment, they hesitate to avail the free service provided under NVHCP.

“National AIDS Control Organization had started launching National AIDS Control Programme to control Human Immuno Deficiency Virus/ Acquired Immuno Deficiency Syndrome from 1990s. So, people of any community including a transgender are fully aware of this disease. But transgenders are still reluctant for the detection and treatment of this disease even though it is a decades-old program. Therefore, it is obvious to have the negligible number of the transgender community for treatment of viral hepatitis B and C that launched very recent,” Naresh observed.

Naresh continued that hepatitis B and C screening are provided through NGOs in collaboration with the health departments for another gender. But such initiative hasn’t taken up exclusively for transgender community. Nevertheless, they suggested or convinced transgender who are suspected to be infected with hepatitis B and C for test and treatment.

So far under their advised, some transgender communities had tested. Amongst them 10 are detected positive. Out of it, nine of them are infected with Hepatitis C and remaining one with Hepatitis B, Naresh while informing that there is a high expectation that screening for NVHCP would be carried out at NGO level as they had pursued basic training about Hepatitis B and C.

When asked about steps taken up by health department to scale up viral Hepatitis B and C test and treat for transgender community, state nodal officer of NVHCP Manipur, Dr RK Rosie said that early detection is the best mechanism to stop spreading of viral hepatitis B and C as this disease is asymptomatic in nature. With this view health department is putting all effort to scale up number test and treat for viral hepatitis B and C for timely intervention by implementing the program even at primary and community health centres. But unfortunately, very few transgenders had come to access the NVHCP.

She further said that transgender community are high risk group of HIV/AIDS and viral hepatitis B and C are one of common co-infectious disease of HIV and AIDS. As such to make NVHCP more fruitful, health directorate took the initiative to work in collaboration with Manipur State AIDS Control Society (MACS).

Rosie said that training was provided to some selective NGOs works under MACS for transgender community to begin screening of viral Hepatitis B and C. “Fear of stigma and discrimination, transgender doesn’t want to come directly at hospital for such treatment. To figure out the infection rate in this community, to work in collaboration with some active NGO is the best option,” she explained.

It may be mentioned that Hepatitis B and hepatitis C are both viral infections that attack the liver, and they have similar symptoms.

The most significant difference between hepatitis B and hepatitis C is that people may get Hepatitis B from contact with the bodily fluids of a person who has the infection. Whereas Hepatitis C spread through blood-to-blood contact. Hepatitis B has a vaccine to protect but the treatment is lifelong once infected. In the case of Hepatitis C, there is no vaccine but it is curable through proper treatment.